Review Question - QID 8998

Patellar tendinitis (PT) is most common among younger athletes and is associated with quadriceps and hamstring inflexibility. Male gender, type of sport and greater height and weight have also been identified as potential risk factors.

Patellar tendinitis (PT) is an overuse injury that results from overload on the extensor mechanism at the bone-tendon junction of the inferior pole of the patella, producing microtearing and degeneration over time. It is particularly common in activities that require repetitive acceleration, deceleration, jumping and deep knee flexion. Conservative management includes activity modification, quadriceps and hamstring stretching, eccentric strengthening, nonsteroidal anti-inflammatory drugs (NSAIDs), and modalities (moist heat, ultrasound, phonophoresis). Surgery should be reserved for patients who fail extensive nonoperative treatment.

Beam et al. reported a case of chronic PT in a 20-year-old collegiate football player that was successfully managed with surgical debridement after failing conservative treatment for over 2 years. He ultimately returned to his pre-injury level of play at 40 weeks postoperatively. The authors recommend that surgical intervention should only be considered after unsuccessful attempts of conservative therapy. Constant pain, inflammation, impairment of sport activity and a visible or palpable enlargement of the tendon are findings which may indicate a beneficial role for surgery. MRI can confirm the clinical findings and define the area and extent of tendon degeneration.

Witvrouw et al. performed a 2-year prospective study of 138 male and female athletes from 9 sports to determine intrinsic risk factors for development of PT. The only significant determining factor was quadriceps and hamstring muscle inflexibility. Height, weight, age, limb alignment (Q angle), leg length discrepancy, and quadriceps and hamstring strength did not predispose to development of PT in this study, although the authors note their small numbers may limited their findings.

Zwerver et al. authored a retrospective cohort study of 891 male and female athletes from 7 sports to evaluate the prevalence of and risk factors for PT. The overall prevalence was 8.5%, was highest among volleyball players (14.4%) and lowest among soccer players (2.5%). PT was twice as common among male athletes compared to female athletes. Athletes with PT were significantly younger, taller and heavier than those without PT.

Figures A and B are T1- and T2-weighted MR images demonstrating signal hyperintensity and tendon thickening at the proximal aspect of the patella tendon, consistent with PT.

Incorrect Responses:
Answers 1, 3, 4 + 5: Male gender, higher weight, quadriceps and hamstring muscle inflexibility and type of sport are associated with an increased risk of PT.